Reduction In Number Of Deaths Research Articles

Childhood cycling fatalities in South Australia before and after the introduction of helmet legislation.

In the years following the introduction of legislation in Australian states mandating the wearing of helmets, there was a decline in the number of deaths. Debate has occurred, however, as to why this occurred. The Traffic Accident Reporting System database, which records data for all police-reported crashes in South Australia, was searched for all cases of deaths occurring in the state in bicycle riders aged ≤14 years from January 1982 to December 2001. The numbers of deaths were then compared over the 10-year periods before (1982-1991) and after (1992-2001) the introduction of helmet legislation, and also on a yearly basis from 1982 to 2001. Comparing the numbers of deaths in the two periods before and after helmet legislation in 1991 showed a marked decrease in cases from 36 to 12. However, in examining the numbers of deaths per year in greater detail, it appears that these were already steadily reducing from nine cases per year in 1982 (2.9/100,000) to two cases in 1991 (0.67/100,000) to a virtual plateau after 1991 (ranging from 0 to 2 cases annually). It seems that the introduction of compulsory bicycle helmet wearing in South Australia came at a time when the numbers of child cyclist deaths had been steadily declining over the preceding decade. While helmet wearing clearly protects children who are still riding bicycles, the reasons for the reduction in numbers of deaths appears more complex than legislative change and likely involves a subtle interaction with other behavioural and societal factors and preferences.

Road safety and traffic medicine in Iran: Achievements and challenges

Road traffic injuries found to be the second rank of Years of Life Lost (YLL) and third rank of Disability Adjusted Life Years (DALY) in Iran based on Global Burden of Disease 2010. The number of annual fatalities, which had been on the rise for several decades, reached to the maximum number of over 27500 deaths in 2005. The number decreased to 23000 in 2010 and less than 18000 in 2013. The reduction in number of deaths happened despite a four-fold increase in number of motor vehicles. Some of the interventions that might be contributing to this achievement include the following: a) the new traffic law passed in 2010 that replaced the previous one dating back to 1968. Heavier penalties for major offences like: speeding, driving under the influence and dangerous driving are considered in the new law; b) stricter law enforcement by traffic polices(1); c) mass media campaign for traffic injury prevention (1); d) using fixed speed camera systems and laser speed guns; e) universal coverage of hospital treatment costs for all traffic injuries by Ministry of Health and Medical Education(2); and f) graduated driving license. On the other side, there are areas that need to be improved, including: a) driving behavior of both public and private drivers; b) driving under influence of drugs specially among public vehicle drivers (3,4) c) motorcycle riding behavior with special emphasis on helmet use (5); d) medical and psychological fitness to drive examinations; e) vehicle safety specifically for cars manufactured within the country; f) transportation engineering with emphasis on expansion of railroads and safe highways.

Cost-effective analysis of screening for biliary atresia with the stool color card.

Biliary atresia (BA) is the leading cause of pediatric end-stage liver disease and liver transplantation in the United States. Early diagnosis leads to improved outcomes, but diagnosis is often delayed, leading to increased rates of transplantation and mortality. A Markov model was developed to simulate the natural history and transplant-related outcomes of patients with BA in a US cohort studied for 20 years. Data regarding proportions of individuals in different health states, including transplant and death, were obtained from published literature. Costs were derived from the literature and the Johns Hopkins database of charges using the cost-to-charge ratio. Strategy A represented the status quo and assumed no screening. Strategy B used nationwide screening with the stool color card developed by the Taiwan Health Bureau. The cost associated with both strategies was compared with the number of life-years gained, deaths, and the number of transplants for a 20-year interval. A dominant strategy was one that was associated with lower cost alongside improved outcomes, including increases in life-years gained, reductions in number of deaths, and reductions in number of transplants. One-way and probabilistic sensitivity analyses were performed. In strategy A, the 20-year cost was $142,479,725 with 3702 life-years, 74 deaths and 158 liver transplants. For strategy B, the cost was $133,893,563 with 3731.7 life-years, 71 deaths and 147 liver transplants. There was a >97% probability that screening with the stool color card would be cost saving and associated with an increase in life-years gained. Among all parameters, only stool color card specificity was associated with the potential for screening to no longer be cost saving. Compared with no screening, screening with the stool color card is a dominant strategy associated with lower costs and better outcomes. These findings suggest that screening with the stool color card could be an important, economically feasible strategy for improving outcomes in BA in the United States.

A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England

ObjectivesTo carry out a programme of linked research studies aimed at improving the management of self-harm, reducing the incidence of suicide and providing reliable data to evaluate the impact of theNational Suicide Prevention Strategy for England(2002).MethodsThere were four research streams: (1) we studied inquest records from 12 coroners and Ministry of Justice data to assess the accuracy of official suicide statistics; (2) we used Office for National Statistics mortality statistics, data from the Multicentre Study of Self-harm in England, national liver unit data, prescription data and patient interviews to assess (a) the impact of paracetamol (acetaminophen) pack size restrictions (1998), (b) the impact of withdrawal of co-proxamol in 2007 and (c) the relative toxicity in overdose of commonly used antidepressants; (3) we carried out 3-month audits of self-harm management in 32 hospitals to investigate variations between hospitals and the impact of management on repeat self-harm; and (4) we developed and piloted letter-based contact interventions aimed at reducing self-harm.Key findings(1) Between 1990 and 2005, the proportion of researcher-defined suicides given a verdict of suicide by the 12 coroners studied decreased by almost 7%, largely because of the increased use of misadventure/accident verdicts for deaths thought, on clinical review, to be suicides. Use of narrative verdicts increased markedly. Coroners who gave more narrative verdicts also gave fewer suicide verdicts, and geographical variations in the use of narrative verdicts appeared to distort reliable assessment of small-area differences in suicide rates. 2(a) UK legislation to reduce pack sizes of paracetamol was followed by a 43% reduction in number of deaths and a 61% reduction in registrations for liver transplantation over the next 11 years. Paracetamol overdoses were often impulsive and some were influenced by media (including the internet); sales outlets appeared mostly to be adhering to sales guidance. Smaller pack sizes of paracetamol for sale in Ireland compared with England did not result in a smaller number of tablets being taken in overdose. There was no clear evidence of an effect of the legislation on prescribing of non-steroidal anti-inflammatory drugs, nor on resulting gastrointestinal bleeds. 2(b) Withdrawal of co-proxamol from use in the UK resulted in approximately 600 fewer deaths than predicted between 2005 and 2010 based on previous trends, with no evidence of substitution by poisoning with other analgesics. 2(c) Of the tricyclic antidepressants, dosulepin and doxepin had the greatest toxicity. Citalopram was more toxic than other selective serotonin reuptake inhibitors. (3) There was marked variation between hospitals in the management of self-harm; effects of this variation on patient outcomes were unclear, although psychosocial assessment may have been associated with reduced repetition. Levels of specialist assessment remained static between 2001–2 and 2010–11, but service quality appeared to improve. (4) Findings of two pilot randomised controlled trials suggested that, although it would be feasible to scale up these interventions to full trials, these interventions might have low generalisability and be of limited benefit to patients.ConclusionWithin the context of the strengths and limitations of the individual studies, this research programme has made significant additions to the evidence base related to suicide and self-harm prevention in the UK.Study registrationA pilot study of a contact and information based intervention to reduce repeat self-harm; ISRCTN65171515.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Grim Face of Maternal Mortality at Tertiary Care Hospital of Rural India: A 16 Years Study

Background: World health assembly set the millennium development goals (MDG) -5, with the aim of reduction in maternal mortality below 100 per 100,000 live births by year 2015. A maternal death is a very sensitive index that reflects the quality of reproductive care provided to the women of the reproductive age. It has serious implications to the family, the society and the nation. The burden of maternal mortality is quite high in India at 254 deaths per 100,000 live births as per the data of Sample Registration System (SRS) for the period 2004-06. However, India is committed to meet the MDG-5 target of less than 100 deaths per 100,000 live births by the year 2015. Objectives: To assess the proportion, causes and time trends of maternal deaths in a tertiary care hospital of rural India. Method: A retrospective hospital based study of 119 maternal deaths over a period of 16 years from January 1994 to December 2009. Results: Over the study period, there were 20,801 deliveries, giving a proportion of maternal deaths of 572/1,00,000 live births. Postpartum hemorrhage was the leading direct cause while infective hepatitis was indirect cause of maternal mortality. Most women died within 24 hours of admission to hospital. There was significant reduction in total number of deaths due to eclampsia and sepsis in last ten years. Conclusions: The proportion of maternal deaths in rural area is much higher than the national figure of 254 maternal deaths per 100,000 live births, yet most deaths in study area could have been avoided by minimizing the three delays i.e. delay in decision to seek care; delay in reaching care and delay in receiving care and by promoting overall safe motherhood.

How many lives can bloody and shocking road safety advertising save? The case of Spain

Abstract At the beginning of the 21st century, the punishment strategies used by the Spanish administration were considerably hardened to achieve a reduction in road accidents. This hardening could also be seen in the mass-media public advertising campaigns, with a marked shift from gentle messages to threat-based advertisements. The goal of this study is to evaluate the effectiveness of this radical change in terms of main road accident indicators and the time that the effects last using multivariate unobserved component models set up in a state space framework applied to monthly series for the 1980–2008 period. The main conclusion is that the effect on reducing road accidents is no greater when citizens are subjected to a greater level of threats in advertising campaigns than would on average be achieved using campaigns with a low level of threats. Secondly, the impact of bloody advertising in Spain is limited to the most serious accidents, those that cause deaths, either on highways or in built-up areas. Moreover, the positive effects progressively decrease as the average lifespan for significant effects of medium and high level campaigns on deaths on highways or in built-up areas was 8 months and almost 12 days. The results show that a reduction in numbers of deaths and injuries is always achieved when the level of harshness in the messages is increased after a period of several years of mild advertising.

Initial experience with off-pump left ventricular assist device implantation in single center: retrospective analysis

BackgroundWe hypothesize that implantation of left ventricular assist device through off-pump technique is feasible and has a comparable result to implantation on cardiopulmonary bypass and could improve one-year survival.MethodsThis retrospective, observational, single-center study was conducted on 29 consecutive patients at our institution who underwent off-pump left ventricular assist device implantation by a single surgeon.ResultsTwenty-seven procedures were performed successfully using the off-pump technique. The survival rate was 92% at 30 days, 76% at 90 days, and 67% at one year. We compared the one-year survival of different implantation periods, and divided our study into three time intervals (2004-2005, 2006, and 2007). There was a trend in reduction in number of deaths over one year that demonstrated a decrease in death rate from 50% to 17%, as well as improvement in our experience over time. However, this trend is not statistically significant (p = 0.08) due to limited sample size.ConclusionsBased upon our findings, off-pump left ventricular assist device implantation is a feasible surgical technique, and combining this technique with improved device technology in the future may provide even greater improvement in patient outcomes.

Screening Men for Abdominal Aortic Aneurysm: 10 Year Mortality and Cost Effectiveness Results from the Randomised Multicentre Aneurysm Screening Study

Conclusion: The mortality benefit of screening men aged 65 to 74 years for abdominal aortic aneurysm (AAA) is maintained up to 10 years after screening. Cost-effectiveness becomes more favorable overtime. Repeat screening of patients whose initial scan result is normal is not justified. Summary: The United Kingdom Multicentre Aneurysm Screening Study (MASS) has provided most of the randomized evidence for mortality benefit for AAA screening (Cochrane Database Syst Rev 2007;CD002945) The authors sought to answer some remaining questions concerning AAA screening, including longer-term benefits of mortality and cost-effectiveness, and whether rescreening after a normal scan result is indicated. The data presented are from the randomized MASS trial with 10 years of follow-up. Data were acquired in four centers in the United Kingdom, with screening and surveillance delivered primarily in primary care centers. The population sample included 67,770 men aged 65 to 70 years. Participants in the original MASS study were allocated to ultrasound screening or to a control group not offered screening. When an AAA was detected, the participants underwent surveillance and were offered surgery if they met prespecified criteria. Main outcome measures have been mortality and costs related to AAA repair and cost per life-year gained. There were 155 deaths related to AAA over 10 years in the group invited for screening (absolute risk, 0.46%) and 296 deaths related to AAA in the control group (0.87%). Relative risk reduction was 45% (95% confidence interval [CI], 37%-57%). The benefits seen in the early years of follow-up were maintained in later years. Incremental cost per man invited to screening was £100 (95% CI, £82-£118), with an incremental cost-effectiveness ratio of £7,600 (95% CI, £5,100-£13,000) per life-year gained. The incidence of ruptured AAA in patients with an originally normal screening result increased after 8 years. Total mortality at 10 years was about 30% in each group, with AAAs comprising about 2% of all deaths. There was no clear difference in any other cause of death, with only a small difference in all-cause mortality (hazard risk, 0.97, 95% CI, 0.95-1.00). There were 25 ruptures that occurred after men had normal initial scan results and 19 were fatal. Rate of ruptures increased noticeably after 8 years of follow-up. Time since initial scan rather than age was the main determinant of the increased risk of rupture. Comment: AAA screening appears to be effective in reducing AAA-related deaths out to 10 years after the initial screening examination. A crucial question is whether rescreening participants is justified at any stage. The authors contend that rescreening is not justified because the number of fatal ruptures occurring after 8 years in the screened group was relatively small. Additional follow-up will be required to determine if there is a noticeable increase in ruptures in the screened group that is not sufficiently offset by the reduction in number of deaths related to the original aortic aneurysm screening.

Measuring progress against cancer in Europe: has the 15% decline targeted for 2000 come about?

BackgroundAgainst a background of increasing cancer rates in the mid-1980s, Europe Against Cancer launched an ambitious programme aiming to reduce cancer mortality by 15% by the year 2000. A programme of activities and research, focussing on three major themes [prevention (particularly tobacco control), screening, and education and training], was developed together with the European Code Against Cancer. MethodsTo evaluate the outcome of the programme, all cancer mortality data were abstracted for each member state of the European Union (EU) until the most recent year available. For each gender group in each member state, age-specific rates were estimated for 2000. For each country–gender grouping, the standardized mortality rate (SMR) and expected numbers of deaths in 2000 were calculated based on the age-specific rates for 1985 and the population estimates for 2000. The ratio of the SMR in 2000 to that of 1985, was used as the measure to compare mortality rates. ResultsIn 1985, there were 850194 cancer deaths in the EU. Based solely on demographic considerations, this number was expected to rise to 1033083 in the year 2000. Between 1985 and 2000, the number of cancer deaths increased in both men (+12%) and women (+9%). The target of a 15% reduction in the expected numbers of cancer deaths in the EU was not met, although the 10% reduction in number of deaths expected in men and 8% in women, along with a 11% reduction in risk of cancer death in men and a 10% reduction in women, was noteworthy. Only Austria and Finland achieved the 15% reductions in deaths in both men and women. The UK and Luxembourg (where the small population and annual number of deaths make interpretation difficult) came close to meeting these targets, as did Italy. Portugal and Greece had the poorest performance, with increases in each gender group. ConclusionsCancer deaths in the EU were expected to rise from 850194 in 1985 to 1033083 in 2000. It is estimated that there will be 940510 cancer deaths that year, due to the decline in risk observed since 1985. The Europe Against Cancer programme appears to have been associated with the avoidance of 92573 cancer deaths in the year 2000. With few exceptions, most countries are experiencing declining trends in cancer death rates, which seem set to continue, at least in the near future. Renewed tobacco control efforts are clearly needed for women, and there is a strong case for the introduction of organized breast and cervix screening programmes in all member states. Continuing to emphasize prevention within cancer control will help to promote the continuing decline in death rates in the future.

Population screening reduces mortality rate from aortic aneurysm in men.

Rupture of an unsuspected abdominal aortic aneurysm is a major cause of death in men over the age of 65 years. A significant reduction in deaths is likely to result only from higher rates of detection and increased numbers of elective aneurysm repairs. Screening of men reaching the age of 65 years has been taking place in the county of Gloucestershire, UK since 1990 and the aim of this study was to investigate any change in the mortality rate from aortic aneurysm in the screened portion of the population. Total number of deaths from all aortic aneurysm-related causes in the county's population was calculated from hospital and post-mortem records, together with computerized death certificate records, for the years 1994-1998. The overall number of aneurysm-related deaths in men aged 65-73 years, who have been progressively influenced by the screening programme, was compared with that for men of all other ages. The total number of aneurysm-related deaths in men aged 65-73 years decreased progressively year by year between 1994 and 1998; this reduction is highly statistically significant (P < 0. 001). No such change was observed in the unscreened part of the population. Screening for asymptomatic abdominal aortic aneurysm results in a significant reduction in numbers of deaths from all aneurysm-related causes in the screened portion of the male population.

Screening for cancer of the cervix in elderly women

Abstract A substantial proportion of women aged over 65 years has not been screened for cancer of the cervix and women in this age group are not included in current screening programmes. This policy is not supported by evidence from the natural history of preinvasive lesions. Since older women present with late disease (and therefore have poor survival) 5-year survival rates adjusted for stage were used to estimate the reduction in number of deaths in women aged 20 years or older (during a 5-year period) if opportunistic screening were to identify more cases of cervical cancer at an earlier stage. 353 lives would be saved and women older than 65 would benefit most, with a 63% improvement in 5-year mortality. Thus, there is no reason to exclude women aged over 65 years from screening for cancer of the cervix.

Screening for cancer of the cervix in elderly women

A substantial proportion of women aged over 65 years has not been screened for cancer of the cervix and women in this age group are not included in current screening programmes. This policy is not supported by evidence from the natural history of preinvasive lesions. Since older women present with late disease (and therefore have poor survival) 5-year survival rates adjusted for stage were used to estimate the reduction in number of deaths in women aged 20 years or older (during a 5-year period) if opportunistic screening were to identify more cases of cervical cancer at an earlier stage. 353 lives would be saved and women older than 65 would benefit most, with a 63% improvement in 5-year mortality. Thus, there is no reason to exclude women aged over 65 years from screening for cancer of the cervix.

Childhood Cancer Mortality

<h3>To the Editor.—</h3> Miller and McKay¹report a decline in US childhood mortality that they attribute "almost entirely" to improvements in therapy. That may be, but they offer no evidence to substantiate that claim. Indeed, there are strong reasons to conclude otherwise. For example, the reduction in number of deaths from leukemia has been observed almost exclusively among those at about age 4 years, whereas no reduction in incidence of death among children older than 10 years has been observed. If therapy is effective in the younger children, why is therapy for the same disease not effective in older children? Second, they demonstrate improvements in mortality for all specific cancer types, for which treatments differ widely. It would be desirable but seems unlikely that all treatments for all cancer types are improving simultaneously on such a broad front. Controlled clinical trials should be the only basis for accepting therapy